Is the National HIV/AIDS Strategy Good for Black Americans? Part 4: Coordinating Care and Funding

By Rod McCullom

October 17, 2010

The final story of a four-part series examining the strategy's impact on Black communities. This article is cross-posted from the Oct. 12 edition of Black AIDS Weekly, the newsletter of the Black AIDS Institute.

In July the Obama administration released the much anticipated National HIV/AIDS Strategy (NHAS) (pdf), the nation's first dedicated road map to addressing and fighting the epidemic. At that time, activists with the Coalition for a National AIDS Strategy described it as "one of the most anticipated moments" in the domestic fight against HIV/AIDS. The strategy identified three primary goals (read parts 1, 2 and 3 of Black AIDS Weekly's report). A fourth metric was later identified: creating a coordinated national response.

The administration offers two "critical" steps toward effectively responding to the epidemic:

Increase the coordination of HIV programs across the federal, state and local governments;

Develop improved mechanisms to monitor progress and report goals.

Funding for HIV/AIDS services originates across the federal bureaucracy, from the Department of Health and Human Services to Veterans Affairs. The NHAS aims to coordinate planning and data collection across these massive organizations. "This is a very ambitious strategy and galvanizes the federal government and the public health community," says Howard Koh, M.D., M.P.H., assistant secretary of health.

Dr. Koh is tasked with coordinating the interagency process to implement the strategy: "We're going to start in the first 150 days and see where the resources are. Then we're going to determine if they're being utilized as efficiently as they should be." (Note: This time frame ends on Dec. 10, 2010.)

The administration hopes to streamline data collection, integrate services, and reduce overlapping and competing programs. "PEPFAR has taught us a valuable lesson about maximizing dollars and resources when fighting HIV," Dr. Koh says, referring to the President's Emergency Plan for AIDS Relief, which has been very successful at delivering lifesaving antiretrovirals to the developing world. "We want to return that sense of urgency to the domestic epidemic."

But while Dr. Koh and the administration describe their coordination plan as "ambitious," others disagreed. "The coordination goals are vague," says Bambi W. Gaddist, Dr.P.H., founder and executive director of the South Carolina HIV/AIDS Council. "And that's being charitable."

How to Monitor Progress?

The second step in coordinating care is developing mechanisms to report progress. The federal government will publish its "progress in reaching strategy goals ... through an annual report" and "encourage states" to do the same, the plan states.

"And that's about it," Dr. Gaddist notes. "There aren't specific coordination goals. There's no accountability, as in how do we make states fall in line?"

Another element missing from the strategy's four-point plan: a price tag. "There's no money here," Dr. Gaddist observes. "And that is a concern. If the strategy is a priority for the administration ... then where's the money?"

The federal funding for domestic HIV/AIDS in fiscal year 2010 was about $19.5 billion. The NHAS allocated no new funding beyond its $30 million implementation cost. In interviews with policy experts, doctors, prevention counselors and HIV/AIDS activists from coast to coast, all decried the lack of funding as problematic.

Jesse Milan Jr., vice president and director of Altarum Institute, a Washington, D.C.-based nonprofit organization that conducts health-systems research, maintains that $30 million is "only a fraction" needed to reduce the escalating HIV rates in the inner cities and the Black community.

"The price tag is very clear," says Milan, who last year chaired the Centers for Disease Control and Prevention's external peer-review committee for the Division of Infection Disease. "That figure is $4.7 billion over five years. That's a minimum. And that's for prevention only."

"There is currently not enough funding for HIV/AIDS in this country," Milan adds. "And those driving the strategy know this."

The administration counters that the NHAS is not a final document but a road map. "This plan informs future budget decisions," Dr. Koh responds. "We have to start with where we are and determine are we using our resources properly."

Milan, the Black AIDS Institute's board-chair emeritus, stresses that African Americans must be "up front" about advocating for more funding. "It's imperative. HIV has a very high impact in the Black community, and we're hurting the most," Milan says, adding that Blacks are experiencing "historically" high HIV seroconversions. In the short term, given the economic and political realities, "we're not likely to see significant increased" HIV/AIDS funding, he adds.

Rep. Barbara Lee (D-Calif.), Congressional Black Caucus chair and a high-profile HIV/AIDS advocate, applauds the NHAS but urges the Black community to lobby for increased funding. "We funded two wars to the tomb with a trillion dollars, so we can find the money. Demand that your members of Congress step up to the plate."

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